Managing no shows via appointment system design.

Abstract

Healthcare systems struggle to match clinic availability with patient demand. Balancing supply with demand becomes more complicated when patients cancel their appointments late or do not show up for their appointments. Late cancellations and no shows can disrupt the delivery of care, increase patient wait times, and lower clinic revenues. These consequences together make it difficult for healthcare systems to contain costs while continuing to improve the quality of care. In this thesis, we study the appointment system design problem with overbooking and consider a new strategy, clinic configuration, to manage no shows. In particular, we evaluate two different clinic configurations – one in which patients with higher no show rates are streamed to special clinics and the other in which all patients are randomly assigned to available doctor clinics. We formulate models to determine which strategy is best suited for a clinic and present numerical experiments which demonstrate that clinic configuration can have a significant affect on the expected net revenue in some cases.